Provider Demographics
NPI:1770036337
Name:HOLMES, JODIE DARLENE (ARNP)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:DARLENE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5352 AMBASSADOR LN W
Mailing Address - Street 2:APT 203
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-4953
Mailing Address - Country:US
Mailing Address - Phone:319-327-7188
Mailing Address - Fax:
Practice Address - Street 1:7658 POPLAR PIKE
Practice Address - Street 2:ADVANCED DERMATOLOGY
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3813
Practice Address - Country:US
Practice Address - Phone:901-759-2322
Practice Address - Fax:563-578-3322
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA116063364SF0001X
TN26431207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health